Involvement of the posterior cingulate gyrus in temporal lobe epilepsy: A study using stereo-EEG

Miguel A Arévalo-Astrada; Ana Suller-Marti; Richard S McLachlan; Elma Paredes-Aragón; Michelle-Lee Jones; Andrew G Parrent; Seyed M Mirsattari; Jonathan C Lau; David A Steven; Jorge G Burneo

doi:10.1016/j.eplepsyres.2023.107237

Involvement of the posterior cingulate gyrus in temporal lobe epilepsy: A study using stereo-EEG

Epilepsy Res. 2023 Dec:198:107237. doi: 10.1016/j.eplepsyres.2023.107237. Epub 2023 Oct 10.

Affiliations

¹ Division of Neurology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, 501 Smyth Box 511, Ottawa, Ontario K1H 8L6, Canada.
² Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada.
³ Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada.
⁴ Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada.
⁵ Epilepsy Program, Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada; Neuro-Epidemiology Unit, Schulich School of Medicine and Dentistry, Western University, 339 Windermere Rd. London, Ontario N6A 5A5, Canada. Electronic address: jburneo2@uwo.ca.

PMID: 37890266
DOI: 10.1016/j.eplepsyres.2023.107237

Abstract

Objective: To analyze the involvement of the posterior cingulate gyrus (PCG) during mesial temporal lobe seizures (MTLS).

Methods: We retrospectively reviewed the stereo-EEG (SEEG) recordings of patients with MTLS performed in our institution from February 2013 to December 2020. Only patients who had electrode implantation in the PCG were included. Patients with lesions that could potentially alter the seizure spread pathways were excluded. We assessed the propagation patterns of MTLS with respect to the different structures sampled.

Results: Nine of 97 patients who had at least one seizure originating in the mesial temporal region met the inclusion criteria. A total of 174 seizures were analyzed. The PCG was the first site of propagation in most of the cases (8/9 patients and 77.5% of seizures, and 7/8 patients and 65.6% of seizures after excluding an outlier patient). The fastest propagation times were towards the contralateral mesial temporal region and ipsilateral PCG. Seven patients underwent standard anterior temporal lobectomy and, of these, all but one were Engel 1 at last follow up.

Conclusion: We found the PCG to be the first propagation site of MTLS in this group of patients. These results outline the relevance of the PCG in SEEG planning strategies. Further investigations are needed to corroborate whether fast propagation to the PCG predicts a good surgical outcome.

Keywords: Posterior cingulate gyrus; SEEG; Seizure propagation; Stereo-EEG; Temporal lobe epilepsy.

MeSH terms

Electroencephalography / methods
Epilepsy, Temporal Lobe* / diagnostic imaging
Epilepsy, Temporal Lobe* / surgery
Gyrus Cinguli / surgery
Humans
Magnetic Resonance Imaging
Retrospective Studies
Seizures
Treatment Outcome